Pharmacology Winter Test 1 L3 Alcohol, Tx, Abuse, Withdrawl

Front 1

what percent of the population has a drinking problem?

Back 1

10%

Front 2

how many people in America have a drinking problem?

Back 2

at least 14 million

Front 3

what is alcohol abuse

Back 3

people who cannot limit their consumption

Front 4

What receptor does alcohol act on in the brain?

Back 4

GABAa

Front 5

What does chronic alcohol use do to GABA receptors?

Back 5

this causes down regulation of receptors via decreases synthesis

Front 6

How does long term alcohol abuse affect glutamate?

Back 6

this inhibits glutamates effect on NMDA receptors

Front 7

How does alcohol chronic use affect NMDA receptors?

Back 7

this upregulates them over time

Front 8

how does alcohol create a stimulant effect at low doses?

Back 8

it inhibits inhibitory pathways, causing disinhibition

Front 9

what does alcohol do at higher doses?

Back 9

this is a CNS depressant and sedative

Front 10

what are the general low dose effects for alcohol

Back 10

impaired intellect and motor function

Front 11

how do you get blackouts from alcohol?

Back 11

Alcohol inhibits glutamate, and which is involved in memory production via NMDA receptors

Front 12

where does alcohol get absorbed in the body?

Back 12

the small intestine

Front 13

how does metabolism of alcohol in the gut differ between men and women?

Back 13

women have much lower levels of gastric alcohol dehydrogenase, o they break less down

Front 14

what does alcohol get broken down to by alcohol dehydrogenase?

Back 14

this gets turned into acetaldehyde

Front 15

What does acetaldehyde get broken down into? by what?

Back 15

aldehyde dehydrogenase breaks it down into acetic acid

Front 16

What cofactor is required to breakdown alcohol?

Back 16

Nad+

Front 17

What is the order of kinetics for alcohol metabolism?

Back 17

Zero order, independent of concentration

Front 18

what does chronic alcohol consumption induce?

Back 18

CYP 2E1 production, which affects alcohol and other drugs metabolism

Front 19

What does Disulfiram (Antabuse) inhibit?

Back 19

this stops aldehyde dehydrogenase, which then leads to acetaldehyde build up in the body- making people sick.

Front 20

How does drinking and taking tylenol become dangerous?

Back 20

long term drinking induces CYP2E1, which leads to fast metabolism of tylenol into a toxic metabolite.

Front 21

what type of tolerance is induce with chronic alcohol use?

Back 21

pharmacodynamic tolerance

Front 22

how does ethanol affect smooth muscle?

Back 22

this is a vasodilator, and can relax the uterus to prevent premature labor

Front 23

how does alcohol affect the kidney?

Back 23

this decreases ADH levels, and thus has a diuretic effect

Front 24

What are the alcohol toxic levels?

Back 24

500mg/dL

Front 25

What are the signs of alcohol toxicitiy?

Back 25

emesis, stupor, coma, respiratory depression, and death

Front 26

What is the treatment of severe alcohol toxicity?

Back 26

airway management, and prevent aspiration

Front 27

What do you give to prevent neurological damage to a person with alcohol toxicity?

Back 27

thiamine

Front 28

What do you give to prevent seizure with alcohol?

Back 28

phenytoin

Front 29

What are hang overs?

Back 29

acetaldehyde build up, dehydration, withdrawal, and toxic compound accumulation

Front 30

What two vitamins are alcoholics deficient in?

Back 30

folate and thiamine

Front 31

What does alcohol do to the pancreas?

Back 31

this damages pancreas cells directly, leading to pancreatitis

Front 32

Where in the GI tract does alcohol cause lesions?

Back 32

in the esophagus, duodenum, and erosive gastritis

Front 33

How common is liver disease with alcohol?

Back 33

15-30% of people who are heavy drinkers develop liver disease

Front 34

how does alcohol affect glutathione levels? what does this do to the liver?

Back 34

this reduces levels of glutathione, which causes oxidative stress and damage to the liver

Front 35

What are the liver damage progression stages? (3)

Back 35

fatty liver -> fibrosis -> cirrhosis

Front 36

What conditions lead to liver cancer?

Back 36

hep C + chronic drinking

Front 37

How does drinking affect the heart?

Back 37

leads to cardiomyopathy
hypertension
and stroke

Front 38

What does a kid with fetal alcohol syndrome look like?

Back 38

microcephaly, mental retardation, flat face, abnormal joints, heart defects

Front 39

how does booze affect sexual function?

Back 39

testicular atrophy
impotence
gynecomastia

Front 40

What is Wernicke-Korsakoff's?

Back 40

Wernickie is encephalopathy of chronic alcoholism (paralysis of eyes, ataxia)

Korsakoff's is chronic memory loss- due to thiamine defect

Front 41

How are the extremities of the body affected by alcohol?

Back 41

peripheral neuropathy
skeletal muscle atrophy

Front 42

What is tolerance to the effect of alcohol called?

Back 42

pharmacodynamic tolerance

Front 43

what is tolerance via increased metabolism of alcohol called?

Back 43

pharmacokinetic tolerance

Front 44

What causes the severe withdrawal syndrome?

Back 44

pharmacodynamic tolerance to the effects of alcohol

Front 45

How are receptors changed in chronic alcoholism?

Back 45

GABA is downregulated, NMDA is up regulated

Front 46

is there a genetic component to alcoholism?

Back 46

yes there is

Front 47

What happens when an alcoholic drinks? what reward pathways?

Back 47

there is a release of B-endorphins in the dopamine reward pathway (ventral tegmental area to nucleus accumbens and prefrontal cortex)

Front 48

What does mild alcohol withdrawal involve?

Back 48

anxiety, irritability, insomnia, nightmares, nausea, tachycardia for 1-2 days

Front 49

What does severe alcohol withdrawal involve?

Back 49

anxiety, fear, hallucinations, delirium, tremors, tonic clonic seizures, arrhythrmias, increased BP

Front 50

What is the general treatment principle for long term alcohol withdrawal?

Back 50

prevent seizures, DT's, and arrhythmias

Front 51

What drugs are given (generally) for alcohol withdrawal?

Back 51

long acting benzos- used to taper out the withdrawal

Front 52

What is haloperidol (Haldol) given for in alcohol withdrawal?

Back 52

this is used to treat hallucinations or aggression in an emergency room setting

Front 53

What is Naltrexone?

Back 53

this is an opioid receptor antagonist, used to block the endrophin effect from drinking booze

Front 54

What does Naltrexone do to help people stop drinking?

Back 54

this reduces the craving, and prevents the reward of drinking

Front 55

How well does naltrexone prevent relapse?

Back 55

this reduces relapse by 50%

Front 56

What are the main side effects of Naltrexone?

Back 56

this cause cause nausea, and liver damage in large doses (beware of alcoholic liver failure)

Front 57

What is Acamprosate (Campral EC), what does it do?

Back 57

this is a structural analogue of GABA- ends up restoring normal GABA/glutamate balance

Front 58

Does Acamprosate affect the liver

Back 58

nope not at all

Front 59

How long is the duration of Disulfiram?

Back 59

3-4 days, very long duration

Front 60

How does Topiramate affect alcoholics?

Back 60

this seems to reduce craving, and increase abstinence in recovering alcoholics

Front 61

What does Fomepizole do?

Back 61

this inhibits alcohol dehydrogenase, prevents conversion of methanol into formate (eventually)

and ethylene glycol into oxalate (eventually)